I would venture that most Day Care people do not know how to bottle feed
correctly (if any of us really know) and use the bottle and a very full
stomach to pacify the baby.
I see this problem also in mothers who bottle feed their children and nurses
bottle feeding babies.
In the hospital where I work we, the LC's, are fighting the battle of
breastfeed babies being supplemented at night and for occasional medical
reasons with larger than necessary amounts of formula.  Babies anywhere from
1-48 hours old receiving amounts ranging from 25- 90cc every 3 hours.  We
have a policy in place on supplementing which states the amount is not to
exceed 15cc but the nurses say the babies are not satisfied (defined as not
settling and going to sleep) so have to give more because they are still
"starving"!
We are strongly trying to discourage mothers from having their babies
supplemented, encourage rooming-in, or at least to feed their babies on
demand at night.  We give them a written explanation of possible
complications that can occur if the babies are supplemented at night.
What I would love to do is give instructions on bottle feeding for the staff
and then it would be required to be given to the bottle feeding Moms prior to
discharge.  Part of this teaching would come from the JHL article on bottle
feeding and the rest would be from just basic knowledge on how the human baby
is supposed to feed.
I would tell them that feedings would need to last on average 20-30 minutes
and therefore they would need to pace the baby accordingly (WOW, this may
discourage many nurses and some Moms from even wanting to bottle feed) then I
would tell them that the baby needs to be sitting up at least 65 degrees, the
bottle angle should not exceed 45 degrees, the bottle nipple is not to be
placed in the baby's mouth until they root and allow it willingly in their
mouth, and when the baby stops active swallowing the bottle is removed
without encouragement to get just a little more in or to finish the bottle.
So no twirling the bottle nipple in the mouth, or rubbing the jaw so the baby
keeps drinking.
I hate the thought that breastfeeding is perceived as hard and requires so
much education and bottle feeding mothers need nothing and assumed that they
will leave the hospital doing everything right!
Sorry for the length and rant but this is one of our biggest blocks to
improve breastfeeding rates.
Ann Perry, RN IBCLC
Boston, MA

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